Long-term technology assessment. Mortality, hospitalization, and work loss due to peptic ulcer and gastritis/duodenitis in the Federal Republic of Germany.

Once the effects of short-term data analysis of new medical technology appear clear, additional or long-term analyses are infrequently performed on subsequent information. This often leads to incomplete understanding of the technology's full medical, social, and economic effects. Available data for the Federal Republic of Germany on mortality, hospitalization, and work loss due to gastric and duodenal ulcer and gastritis/duodenitis allowed long-term analysis of direct and indirect impacts on the population from 1975 through 1984. Mortality rates declined for all ages (p less than 0.01) except for those age 75 and older, and nearly equally for all study diagnoses. Hospital discharge rates for all diagnoses rose slowly and steadily, while those for persons diagnosed with gastric ulcer, duodenal ulcer or gastritis/duodenitis declined sharply (p = 0.04). Declines of hospital discharges were greater for men than for women. The ongoing decline in rates of mortality and hospital discharges increased after 1977. Rates of work loss per 10,000 population-at-risk for study diagnoses were either stable or increasing until 1979, after which there was a marked decline (p = 0.03 for gastric ulcer, p = 0.02 for duodenal ulcer, p = 0.008 for gastritis/duodenitis). Work loss due to study diseases declined as a percentage of work loss for all diseases during the later study years. Only by examining many years' data could the accelerating declines be discerned, not only for mortality and hospitalizations, which have been examined before, but also for work loss, an infrequently analyzed effect of disease.     

Bleeding peptic ulcer: an audit of conservative management.

One hundred and twenty-six of 157 consecutive patients (80%) admitted for a bleeding peptic ulcer were treated conservatively and retrospectively analysed. There were 52% duodenal, 41% gastric and 7% combined ulcers. The initial shock index (pulse/systolic blood pressure) was in excess of one in 10%. For 22% of the patients no transfusion was required but 10% had more than 6 units of blood during their hospital stay. Forty-nine per cent were on nonsteroidal anti-inflammatory drugs and 83% had at least one coexisting systemic disease. Six patients (5%) had a further haemorrhage, four of whom died. A total of 10 patients (8%) died. Five of them were related to the peptic ulcer disease but also had terminal or multiple systemic diseases precluding any surgery. Their poor short-term prognosis shows how difficult it will be to effectively reduce the mortality in this particular group of conservatively treated patients, even with the recent advent of endoscopic haemostasis, and stresses the importance of carefully identifying high risk patients in trials mounted to improve on the current mortality figures.     

Sex and smoking differences in duodenal ulcer mortality

Data from the US Census Bureau and the National Center for Health Statistics suggest that differences in male and female smoking habits between 1920 and 1980 may have contributed to changes in duodenal ulcer mortality sex ratios. An attributable risk analysis suggests that between 43 per cent and 63 per cent of duodenal ulcer mortality for males results from smoking; the comparable figures for females being between 25 per cent and 50 per cent.     

Perforated duodenal ulcer and cigarette smoking.

Whilst the association between smoking and peptic ulceration has been reported previously, the relationship between smoking and the complications of ulcers, such as perforation, bleeding or acute painful exacerbation, has not been examined. In a retrospective study comparing 275 emergency admissions for peptic ulcer with 275 controls, cigarette smoking was significantly more common only in those with a perforated duodenal ulcer. Of 128 patients with perforated duodenal ulcers, 110 (86%) were cigarette smokers compared with 65 (51%) of the 128 matched controls (X2, P less than 0.01). Cigarette smoking in patients with bleeding or acutely exacerbated ulcers was not significantly more common than in controls. These findings strongly suggest a particular association between smoking and perforated duodenal ulcer.     

Peptic ulcer disease in a general adult population: the Kalixanda study: a random population-based study

The authors' aim in this study was to explore the prevalence, symptomatology, and risk factors for peptic ulcer in a general adult population. Between December 1998 and June 2001, the authors surveyed a random sample (n=3,000) of the adult population (n=21,610) in two communities in northern Sweden using a validated questionnaire, the Abdominal Symptom Questionnaire (response rate=74%). A subsample (n=1,001) of the responders was randomly invited to undergo esophagogastroduodenoscopy and symptom assessment (response rate=73%). The prevalence of peptic ulcer was 4.1% (20 gastric ulcers and 21 duodenal ulcers). Nausea and gastroesophageal reflux were significant predictors of peptic ulcer disease, but epigastric pain/discomfort was not. Six persons with gastric ulcer and two persons with duodenal ulcer were asymptomatic. Eight subjects with duodenal ulcer (38%) lacked evidence of current Helicobacter pylori infection. Five (25%) of the gastric ulcers and four (19%) of the duodenal ulcers were idiopathic (no use of aspirin or nonsteroidal antiinflammatory drugs, no H. pylori infection). Smoking, aspirin use, and obesity were risk factors for gastric ulcer; smoking, low-dose (相似文献   

The incidence of duodenal and gastric ulcers in a large health maintenance organization.

We report the incidence of peptic ulcers (duodenal, pyloric canal, gastric, and combined) verified by radiologic, endoscopic, or surgical evidence in a large Health Maintenance Organization (HMO) in Los Angeles, California. For members age 15 and above, the peptic ulcer incidence rate was 0.86 per 1,000 person-years (p-y) (males 1.10, females 0.63). The male to female sex ratio was 1.7. Two hundred twenty-two duodenal, 17 pyloric canal, 89 gastric, and 21 combined first-time diagnosed ulcer cases were located. For duodenal and pyloric canal ulcer, the incidence rate for members age 15 and above was 0.58 per 1,000 p-y (males 0.76, females 0.40). For gastric ulcer, the incidence rate for members age 15 and above was 0.21 per 1,000 p-y (males 0.23, females 0.18). The combined ulcer rate was 0.05 per 1,000 p-y (males 0.07, females 0.02). Gastric ulcer rates were two times higher in 1980 than in 1977. Peptic ulcer age-specific incidence rates increased with age. Incidence rates were much lower than those reported in previous studies, but the gastric to duodenal ulcer ratio and the age and sex relation to ulcer incidence were similar to those previously reported.     

Aetiology of peptic ulcer: a prospective population study in Norway.

STUDY OBJECTIVE--To analyse simultaneously the effect of several risk factors for peptic ulcer. DESIGN--Cohort study where all patients with new or incident peptic ulcers in a well defined population were registered for a seven year period. The follow up started with a comprehensive health survey including a questionnaire on diet, lifestyle, psychological and social conditions, and health. Relative risks, both sex specific and separate, for gastric and duodenal ulcers were estimated from proportional hazard regression analysis. SETTING--A population based survey conducted in the municipality of Tromsø, northern Norway. PARTICIPANTS--In 1980, a total of 21,440 men and women, aged 20 to 54 years and 20 to 49 years respectively, were invited to participate. A total of 14,667 people attended and returned the questionnaire. MAIN RESULTS--A total of 328 people had their first peptic ulcer in the follow up period. Age, cigarette smoking, first degree relatives with peptic ulcer, and low educational level were shared risk factors for peptic ulcer in both men and women. In men, frequent upper respiratory infections increased the risk of gastric ulcer and drinking a great deal of milk increased the risk of duodenal ulcer. None of the other dietary variables, including coffee and alcohol consumption, contributed significantly to the risk. Use of analgesics was not a risk factor, and none of the psychological indicators analysed carried any significant risk. CONCLUSIONS--Age, inheritance, and cigarette smoking are all important risk factors for peptic ulcer. The increased risk associated with low educational background indicate that social strains, comprising lifestyle and diet habits, are part of the multifactorial aetiology of peptic ulcer. No support was found for the assumption that peptic ulcer disease is a psychosomatic disorder. This study did not support the view that duodenal and gastric ulcers have different aetiologies-rather it showed a similarity in risk patterns.     

Occupational mortality from gastric and duodenal ulcer

The pronounced geographical and temporal variations in gastric and duodenal ulcer suggest that important environmental factors must play a part in their aetiology. To determine the nature of possible factors, the Registrar General's decennial supplement and the vital statistics special reports of the United States Department of Health, Education, and Welfare on occupational mortality were analysed for occupation-specific mortality from peptic ulcer. The data disclose a high mortality from both types of ulcer among manual workers and a low mortality among sedentary occupations. This general pattern runs parallel to a low mortality from gastric and duodenal ulcer among the high social classes and a high mortality in the low social classes. Married women displayed a gradient of gastric ulcer mortality increasing from social class 1 to social class 5 but gave no evidence of social class correlation with respect to duodenal ulcer. The significant correlation between mortality from gastric and duodenal ulcer among different occupations could suggest that both types of ulcer hold some of the precipitating environmental risks in common. In duodenal ulcer the varying extent of energy expenditure among different occupations may be responsible for the different risk of contracting duodenal ulcer and dying from it. The association between energy expenditure and peptic ulcer mortality seems to be less important for gastric ulcer where additional factors associated with social class may also be operating.     

Occupational mortality from gastric and duodenal ulcer.

The pronounced geographical and temporal variations in gastric and duodenal ulcer suggest that important environmental factors must play a part in their aetiology. To determine the nature of possible factors, the Registrar General's decennial supplement and the vital statistics special reports of the United States Department of Health, Education, and Welfare on occupational mortality were analysed for occupation-specific mortality from peptic ulcer. The data disclose a high mortality from both types of ulcer among manual workers and a low mortality among sedentary occupations. This general pattern runs parallel to a low mortality from gastric and duodenal ulcer among the high social classes and a high mortality in the low social classes. Married women displayed a gradient of gastric ulcer mortality increasing from social class 1 to social class 5 but gave no evidence of social class correlation with respect to duodenal ulcer. The significant correlation between mortality from gastric and duodenal ulcer among different occupations could suggest that both types of ulcer hold some of the precipitating environmental risks in common. In duodenal ulcer the varying extent of energy expenditure among different occupations may be responsible for the different risk of contracting duodenal ulcer and dying from it. The association between energy expenditure and peptic ulcer mortality seems to be less important for gastric ulcer where additional factors associated with social class may also be operating.     

Peptic ulcer among urban bus drivers in Denmark

As part of a survey on the work environment of bus drivers, 2045 (83%) of 2465 male bus drivers in the three major cities in Denmark in 1978 answered a postal questionnaire on health and working conditions. In order to evaluate the relative occurrence of peptic ulcer among the bus drivers, a follow-up study was also conducted. All hospital discharges with a peptic ulcer diagnosis among the bus drivers were registered from the Danish National Patient Register. All Danish men were used as reference group. On the basis of the 1978-questionnaire association between occupational and psychosocial factors and subsequent hospital discharge with a peptic ulcer diagnosis was studied. The prevalence of abdominal pain alleviated by food intake was 12% among bus drivers and 6% in the reference group. The incidence of hospital discharge with duodenal ulcer among younger bus drivers was twice the incidence among Danish men in the same age group. The incidence of all manifestations of peptic ulcer disease among bus drivers did not differ from the incidence among Danish men. Of occupational and psycho-social factors, wage dissatisfaction and smoking showed statistically significant association with hospital discharge with PU in a 6 3/4-year period. Job dissatisfaction, stress symptoms and lack of some social network factors tended to increase the risk of hospital discharge with PU.     

The prevalence of self-reported peptic ulcer in the United States.

OBJECTIVES. The purpose of this study was to draw a current picture of the sociodemographic characteristics of peptic ulcer in the United States. METHODS. During the National Health Interview Survey of 1989, a special questionnaire on digestive diseases was administered to 41,457 randomly selected individuals. Data were retrieved from public use tapes provided by the National Center for Health Statistics. Odds ratios were calculated by logistic regression after adjustment for sample weights in the survey. RESULTS. Of adult US residents, 10% reported having physician-diagnosed ulcer disease, and one third of these individuals reported having an ulcer in the past year. Old age, short education, low family income, being a veteran, and smoking acted as significant and independent risk factors. Gastric and duodenal ulcer occurred in both sexes equally often. Duodenal ulcer was more common in Whites than non-Whites, while gastric ulcer was more common in non-Whites. CONCLUSIONS. The age-related rise and socioeconomic gradients of peptic ulcer represent the historic scars of previous infection rates with Helicobacter pylori. The racial variations reflect different ages at the time of first infection; younger and older age at the acquisition of H. pylori appear to be associated with gastric and duodenal ulcer, respectively.     

A prospective study of gastric and duodenal ulcer and its relation to smoking, alcohol, and diet.

The effects of environmental exposures on the development of gastric and duodenal ulcers were investigated in a prospective study of 7,624 American men of Japanese ancestry in Hawaii. After 149,291 person-years of observation, there were 280 incident cases of gastric ulcer and 149 incident cases of duodenal ulcer. The risk of both gastric and duodenal ulcers progressively increased with increasing pack-years of cigarette smoking. In contrast, alcohol intake was not associated with either type of ulcer. The risk of gastric ulcer was positively associated with the use of table salt/soy sauce, but there was no association with the consumption of other oriental foods. The risk of duodenal ulcer was inversely associated with western style diet around 1940 and with bread intake of two or more servings per day. The authors did not find any protective or adverse effect of milk and fruit consumption on peptic ulcer risk.     

Recent trends in fatal poisoning by opiates in the United States.

Deaths in the United States classified as unintentional poisoning by drugs and medicaments fell from 14.7 per million population in 1975 to 8.8 in 1978, a 40 per cent decrease. Seventy-three per cent of this drop attributable to a reduction in deaths coded to opiates and intravenous narcotism. These two categories accounted for 38 per cent of all unintentional drug deaths in 1975 but only 15 per cent in 1978. There was no simultaneous increase in other drug-related deaths, including suicides, to account for the reduction in deaths coded to opiates. The highest mortality rates and the greatest variation in mortality during 1970-78 occurred in 20-29 year old non-White males. Racial and sex differences in opiate poisoning mortality, notable early in the decade, were greatly reduced by 1978 due to a relatively larger decline in mortality of males and non-Whites. Time trends in mortality from opiate poisoning appear to coincide with variations in the amount of heroin smuggled into the country.     

Diverging trends in cardiovascular morbidity and mortality in a low risk population

Cardiovascular (CVD) disease morbidity and mortality are changing over the years, following changes in socioeconomic conditions and underlying risk factors. However, the trends of these changes differ among various populations. There is little data regarding these trends in low CVD risk populations. Tables of deaths by cause and age for the period 1956–2007 and tables of hospitalizations for the period 1979–2003 published by the National Statistical Service of Greece were used. Trends over time were determined using log-linear regression models. Age-adjusted all-cause mortality has declined steadily since 1964 in both sexes. CVD mortality initially increased until the late 1980s and subsequently decreased. An increase in mortality from stroke was seen until 1978, especially in men, followed by a decline. Mortality from coronary heart disease (CHD) increased initially, continued to increase for one decade more than stroke and started to decrease in 1989. However, only in women has CHD mortality returned below 1956 levels. As a result, deaths from CHD have surpassed those from stroke. Although the in-hospital fatality of acute myocardial infarction (AMI) has decreased by half between 1979 and 2003, deaths from AMI have decreased only slightly, as hospitalization and morbidity rates have increased during the same period. Although the various types of CVD share common risk factors, the trends of their respective mortality rates have differed significantly over the past five decades in the Greek population. This could partly be explained by the fact that risk factors do not equally contribute to CHD and stroke, and they might have not all been equally well controlled.     

NSAIDs相关性溃疡(综述)

进一步确定NSAIDs在消化性溃疡发生及上消化道出血中的作用,回顾近10年来NSAIDs相关性溃疡的预防和治疗方法,NSAIDs与消化性溃疡的关系密切,且与幽门螺杆菌在消化性溃疡的发生中有协同作用,积极预防可避免消化性溃疡的发生.     

Years of potential life lost (YPLL) before age 65 in Italy.

The Italian death rates and years of potential life lost (YPLL) for all causes and for 12 selected aggregations of causes are reported for 1979 and 1983, with the latter compared to United States data. Cancer is the leading cause of YPLL in Italy (23.8 per cent of total YPLL), followed by unintentional injuries (16.3 per cent) and heart disease (11.2 per cent). Rates of YPLL for all causes decreased 12.0 per cent from 1979 to 1983, the strongest declines in absolute terms being observed for prematurity and unintentional injuries, and in percentage decline for pneumonia and influenza, and infectious diseases; during the same period, YPLL for diabetes increased. The rates of YPLL are higher for males than for females (rate ratio = 1.9) especially for causes related to lifestyle factors. Premature mortality is lower in Italy than in the USA, because of the striking difference in mortality from injuries and heart diseases.     

Disability pensions due to peptic ulcer in Germany between 1953 and 1983

In the present study, the number of disability pensions provided in West Germany between 1953 and 1983 because of peptic ulcer served as a marker of peptic ulcer morbidity. A total of 46,426 cases of disability resulting from peptic ulcer occurred, representing 0.6% of all cases of disability in West Germany during this period. Blue collar workers were affected more often than white collar workers, and men more often than women. The proportion of disability pensions due to peptic ulcer markedly declined between 1953 and 1973. This decline affected both sexes and both blue and white collar workers and was accompanied by a shift of the highest age-specific proportions from the middle to the older age groups. These findings show that the previously observed temporal variations of peptic ulcer disease do not apply only to the mortality but also to the prevalence of peptic ulcer.     

Epidemiology of peptic ulcer in north Bengal, India.

A retrospective analysis of hospital records of inpatients of Medicine department of North Bengal Medical College and Hospital during the period between 1988-90 revealed that 6.2% of all medical admissions were on account of peptic ulcer and or acute gastritis. Duodenal ulcer was prevalent accounting for more than 50% of the cases of peptic ulcer and acute gastritis. Duodenal ulcer was more common in the working age groups (> 21 years) among males and more than 31 yrs among females. Gastric ulcer was more common among older age groups. In respect to ethnicity, Bengali speaking hindus showed high probability for gastric ulcers in both sexes. The probability for duodenal ulcer was within confidence limits among all social groups.     

Validation of diagnoses of peptic ulcers and bleeding from administrative databases: a multi-health maintenance organization study

The automated health plan data and data from medical chart abstractions from eight large health maintenance organizations were used to evaluate the positive predictive values (PPVs) of the International Classification of Diseases, 9th revision (ICD-9) codes for cases of peptic ulcers and upper gastrointestinal bleeding. Overall, 207 of 884 cases of peptic ulcers and upper gastrointestinal bleeding (23%) were confirmed by surgery, endoscopy, X-ray, or autopsy. The PPVs were 66% for hospitalizations with codes for duodenal ulcer (ICD-9-CM 532), 61% for gastric/gastrojejunal ulcer (ICD-9-CM 531, 534), 1% for peptic ulcer (ICD-9-CM 533), and 9% for gastrointestinal hemorrhage (ICD-9-CM578). The overall and diagnostic category-specific PPVs were generally similar for the various HMOs. This study, using data from a large number of health plans located in different geographical regions, underscores the importance of evaluating the accuracy of the diagnoses from automated health plan databases.